Firefighter 1 Student Packet-150727

ww

w.erie.gov/fire

County of Erie Department of Emergency Services Division of Fire Safety

NYS OFPC Firefighter 1 Student Packet CONTENTS:

Course Preparation Suggestions SCBA Face Piece Seal Protection Policy Typical Reading & Skill Assignments Learning Agreement Letter to Fire Chiefs NYS OFPC Training Authorization Form

As of: 5/5/15

Firefighter 1 Course Preparation Suggestions:

Delivery of this 91-hour Firefighter 1 course will be very labor intensive for both the students and the instructors. Some sections of this course are very physically and intellectually challenging. If you are not conditioned, you may struggle to get through the evolutions necessary to pass the course. While everyone involved is dedicated to ensuring your success, you must be equally dedicated and prepared.

If you have any physical or learning limitations that may impact your successful completion of the course, please make the lead instructor aware of the situation prior to, or at the start of the course.

Following is a list of suggestions to better prepare you before coming to your assigned course:

1. All of the required reading is from the IFSTA/Brady Essentials of Firefighting and Fire Department Operations-6th Edition. This book is required at the first class (orientation) and they may be purchased at the Fire Safety Office at a cost of $85 each. Your fire company or fire district will be billed by the Erie County Fire Chiefs Mutual Aid Organization. If you are purchasing elsewhere – be sure that you are buying the version that includes “Fire Department Operations.”

2. Complete the Introductory Incident Command Course IS-100 course online at: http://training.fema.gov/emiweb/is/is100b.asp and bring your certificate of completion with you to class.

3. Practice putting on and taking off your Personal Protective Equipment (PPE), including gloves and hood. Make sure that the PPE is good fitting and compliant for the fire service. No non-compliant fire gear will be permitted.

4. Practice ‘donning and doffing’ your SCBA on top of your PPE. The national standard we will be striving for is for you to don your complete PPE and SCBA in less than two minutes by the third unit of the course.

5. Be sure to always have hydration materials with you and hydrate frequently.

6. All registered students and designated alternates must bring the following items to the first unit of the course:

o Completed and signed NYS OFPC Training Authorization Letter (Form can be downloaded from www.erie.gov/fire)

o IFSTA/Brady Essentials of Firefighting and Fire Department Operations book-6th Edition.

o Complete set of Personal Protective Equipment including helmet, hood, coat, pants, boots, firefighting gloves and complete SCBA with one extra spare SCBA bottle (two total.) All SCBA bottles must be hydrostatic tested compliant. Face pieces must be fit tested.

o One (1) 15 ft. length of ½” kern mantle rope (no close line)

7. All registered students must attend the first unit of the course or their seat will be forfeited. Contact the instructor if you are unable to attend the first unit.

8. Erie County Fire Safety SOG#1011 “Unexcused Absence Policy” and associated fees apply to all students who fail to attend the first unit of any course without proper notice.

9. Fire departments sending recruits to the Firefighter 1 course are expected to provide equipment, manpower and/or apparatus as requested to assist in the course delivery. Please be sure all equipment has been properly inspected and certified including hose, ladders, pumps etc. See attached class schedule/reading assignments for list of needed equipment.

cc: Fire Chief As of: 5/5/15

ERIE COUNTY DIV. OF FIRE SAFETY – TRAINING GUIDELINES

SOG# SUPERSEDES CREATED LAST UPDATED REVISION# 1009 --- 03/02 --- 0

SECTION AREA Training SCBA Face-piece Seal Protection

1009.01 Scope: This training procedure establishes guidelines for ensuring the safety of training participants with facial hair or other conditions that may impede the SCBA face-piece to face seal. 1009.02 Background: While it is the responsibility of each firefighter’s employer to ensure their compliance with appropriate OSHA regulations, it is ultimately the responsibility of Erie County Fire Safety Instructors to ensure the safety of all participants. Thus, it is this division’s policy to enforce compliance with OSHA Respiratory Protection Standard 29 CFR 1910.134 of students participating at county training facilities or under the direction of county fire instructors. This policy is a reiteration of the above mentioned OSHA standard and OSHA’s standard interpretations of this policy. 1009.03 Seal Protection Policy: Per the above referenced OSHA standard, students shall not be allowed to wear SCBA or be permitted to participate in evolutions which may expose them to smoke or toxic environments (live fire):

1. If they have facial hair (including beard, goatee or moustache) that comes between the sealing surface of the face-piece and the face

2. If they have any other condition that may interfere with a proper face to face-piece seal or valve function

This is applicable to fire training situations as well as confined-space training programs.

New York State Instructional Guide – Firefighter I

Office of Fire Prevention and Control Page

NYS FIREFIGHTER I

COURSE SCHEDULE

NFPA 472 [2013] & 1001 [2013]

DATE/TIME LOCATION

Unit / Time

UNIT READING

Unit 1

3 hours

Orientation - Registration, Attendance, Testing, and Course Overview; Issue take home skills; Intro to Fire Service/FD Organization; FF Safety [Officer orientation]

IFSTA Ch 1; Ch 2

Unit 2

4 hours

Firefighter PPE; SCBA presentation; PPE/SCBA skills 6-I-1 to 6-I-5, 6-I-10 to 6-I-12, 9-I-9

IFSTA Ch 6

Unit 3

4 hours

complete PPE/SCBA Skills; SCBA Emergencies; TOAC; homework quiz issued

Unit 4

3 hours Fire Behavior – brief reading assessment

IFSTA Ch 5

Unit 5

4 hours Haz Mat presentation IFSTA Ch 23

Unit 6

4 hours Haz Mat presentation IFSTA Ch 23

Unit 7

4 hours Haz Mat presentation; Haz Mat activities 24-I-7 to 11

IFSTA Ch 24

Unit 8

4 hours

Haz Mat Skills 24-I-1, 24-I-2, 24-I-12; Haz Mat written exam; Haz Mat activities continued

IFSTA Ch 24

Unit 9

3 hours Building Construction presentation IFSTA Ch 4

Unit 10 3 hours FD Communication/Portable Ext Present

IFSTA Ch 3; Ch 7

Unit 11 3 hours

Ropes/ Knots/ Scene lighting presentation; homework quiz issued; Skills 8-I-2 to 8-I-18

IFSTA Ch 8; pgs. 479-484

Unit 12 4 hours

Structural search; Victim Removal; Skills 9-I-1, 3, 4, 5, 6, 7, 17 IFSTA Ch 9

Unit 13 4 hours

Ground ladders presentation; mid-term exam; Skills 12-I-2, 3, 6, 7, 8, 9, 10, 16, 17

IFSTA Ch 12

Unit 14 4 hours

Ladder skills continued; 12-I-4, 5, 12, 18, 19

New York State Instructional Guide – Firefighter I

Office of Fire Prevention and Control Page

Unit 15 3 hours

Forcible Entry/Tactical Vent presentation; homework quiz issued

IFSTA Ch 11; Ch 13

Unit 16 4 hours

Forcible Entry/Tactical Vent Skills 11-I-3 to 8, 13-I-1 to 3, 13-I-5 to 8

Unit 17 3 hours Water Supply/Hose presentation

IFSTA Ch 14; Ch 15

Unit 18 3 hours Fire Streams presentation IFSTA Ch 16

Unit 19 4 hours

Hose Skills 14-I-1 to 4; 15-I-5, 9, 12, 15, 24, 25, 26, 27; 16-I-1 to 3, 17-I-7

Unit 20 3 hours

Fire Control presentation; homework quiz issued

IFSTA Ch 17

Unit 21 4 hours

Survival Skills: 9-I-8, 11, 11 A, 12, 12 A, 14, 15, 16

Unit 22 4 hours

Initial Company Ops - see instructor direction

Unit 23 4 hours

Vehicle Fires and Portable Extinguishers; Skills 7-!-1 to 3, 17-I-8

Unit 24 4 hours Structural fires 1; Skill 17-I-1 A

Unit 25 4 hours Structural Fires 2; Skill 17-I-1 B

Unit 26 3 hours

Loss Control/Origin and Cause presentation; Activities 18-I-8 to 11

IFSTA Ch 18; Ch 19

Unit 27 3 hours

Life safety initiatives/CS Awareness presentation; homework quiz issued; review

IFSTA Ch 21; pgs. 538-540

Unit 28 4 hours Skills review and testing

Unit 29 3 hours

Testing - written/skills

1. 16 Homework skills to be signed off by home FD: NYS Skill Sheets 2-I-1; 2-I-2; 6-I-6 &

7; 6-I-8 & 9; 8-I-1; 10-I-1; 11-I-1; 11-I-2; 12-I-1; 15-I-1 & 2; 15-I-3 & 4; 15-I-6; 15-I-10 & 14; 15-I-11 & 14; 18-I-1, 2 & 3; 18-I-6 & 7.

2. Students required to complete First-Aid, CPR, I-100.b, and IS-700.a prior to graduation to receive certificate

3. Reading assignments to be completed before class listed. 4. If combined BEFO course, students will attend the pertinent units as listed in Basic

Exterior Firefighting Operations 42 hour model 5. Take home quizzes are due at session following issue.

Firefighter 1 Learning Agreement NYS Firefighter I is designed to prepare entry level firefighters to respond to emergencies. This course is designed to accomplish the objectives of NFPA 1001 and NFPA 472 and trains the entry level firefighter as an interior structural firefighter in accordance with OSHA regulations 1910.156 Fire Brigade Standard, 1910.134 Respiratory Standard, 1910.120 Emergency Response to Hazardous Materials, 1910.146 Confined Space Entry Standard and 1910.147 Control of Hazardous Energy Standard. This course is 91 hours in length, which is broken up into 29 lessons which will be accomplished in night and weekend sessions. Tests and measurements are a necessary element in the learning process. Student Attendance: Sessions must be attended. In the event of an unavoidable absence, the student shall notify the lead instructor. The student may have to make up the class in order to pass the course. Student Obligations: Students are provided with a copy of the Firefighter I outline. Students shall have completed the required reading and be prepared for unit tests, and to participate in discussions. All students shall bring with them to class; personal protective equipment, writing instrument and paper unless otherwise indicated by the instructor. Completes the NIMS 700 self study and provides proof of completion to the instructor prior to the completion of the class. The NIMS test can be obtained from the instructor or through a web site. Written Exams: All students will be given at least two written exams. The midterm exam is conducted in lesson 13, and the final exam at the end of the course. Both exams require a passing grade of 70% or better. All students must pass both of these two exams to receive credit for the course. If a student fails any of the written tests, then they will be allowed to retake it (only) once at the convenience of the instructor or if the instructor is unavailable, they will have to retake the exam in another class. Failing the retake of the exam requires taking the course over again. Practical Skills Evaluations: All students will be given skills during various times during the program. Every student is expected to pass all skills. If a student fails a skill, the instructor may elect to provide a make-up for that particular skill or remove the student from the class. Physical Fitness: All students must be fit enough to safely complete skills. Students must have been determined to be fit for firefighting and must have received a fit test for the equipment that they are using in the course. Students will be training in an IDLH atmosphere during the course.

PERFORMANCE EXPECTATIONS Judgment: Makes reasonable, safe decisions when attempting to accomplish a task or solve a problem Is courteous and respectful Handles interpersonal conflicts effectively Communication: Uses appropriate tone of voice Articulates in a clear, logical and understandable manner Displays Confidence Is persuasive and makes a positive impression Demonstrates appropriate non-verbal communication techniques Teamwork: Effectively works with others in order to accomplish tasks or solve problems Offers help to team members when needed Consistently demonstrates safe practices for self and others Problem Solving: Approaches problems in a safe, logical, and well thought out fashion Seeks pro-active solutions to problems Initiative/Motivation/Work Ethic: Accomplishes tasks or goals without being ordered, coerced or motivated by others Demonstrates desire for personal and professional development Accomplishes tasks or goals with a “safety first” attitude Takes on additional tasks or duties Actively seeks academic and technical knowledge for self improvement Is reliable in following safety practices in all situations Adaptability/Stress Management: Remains calm in stressful situations Adapts behavior in order to deal with changing situations in a safe manner Adapts behavior in order to accomplish individual and or/organizational goals Recognizes symptoms of stress in self and seeks to deal with stress appropriately Integrity: Is sincere and honest when dealing with others Keeps commitments Respects personal property of others/their departments Portrays professional image in speech, action and appearance Obeys all policies of the Office of Fire Prevention & Control and the hosting agency I have read and understand the agreement as written above and will abide by all the above policies. I understand that I will be held accountable for any actions that are not in accordance with the above. I understand that I will be removed from class and not be able to continue in the class if I do not abide by these performance expectations. __________________________ ___________________________ ___________ Print Name Sign Name Date

County of Erie

MARK POLONCARZ COUNTY EXECUTIVE

DEPARTMENT OF EMERGENCY SERVICES Division of Fire Safety

EMERGENCY SERVICES TRAINING & OPERATIONS CENTER 3359 Broadway – Cheektowaga NY 14227

www.erie.gov/fire – [email protected] 716/681-7111 – FAX/681-3645

Dear Fire Chief or Training Officer:

Your firefighter has enrolled in a Firefighter I training course conducted by the New York State Office of Fire Prevention and Control. We strive to give your firefighter the best fire training experience and we are asking for your support during this course to accomplish that goal. Your leadership and guidance will help your firefighter succeed.

The instructor team and the training center staff are very excited about this training opportunity to emphasize learning, discipline, respect, teamwork, camaraderie, and resourcefulness – preparing your recruit to be “combat ready.”

The orientation is the first lesson of Firefighter I. Please see the emergency services training schedule for the date and time of the first (orientation) class for your recruit’s Firefighter I Course.

This lesson provides the student with course requirements, instructor expectations and course completion policies to prepare the student firefighter for the educational tasks ahead.

Accompanying your firefighter to this orientation lesson would demonstrate your commitment to your firefighter’s training and demonstrate the importance you place on your firefighter being well trained and prepared to perform the best, but most dangerous job in the world.

At this lesson the instructor will explain any need for your department to supply equipment, apparatus and, occasionally, experienced firefighters to assist in the training of your firefighter.

Please ensure that your firefighter brings a completed and signed New York State Office of Fire Prevention and Control Training Authorization letter. That letter must be signed by a chief officer stating the student has completed a mask fit test and received medical clearance for S.C.B.A. use. This form is included in this packet or can be downloaded from the Erie County Fire Safety web site at http://www.erie.gov/fire.

If possible, please accompany your firefighter to the orientation lesson. If you are unable to attend, please send an assistant chief, training officer or other appropriate representative.

Our team of state fire instructors looks forward to meeting with you and aiding in the development of your new firefighter.

Please carefully review all of the information in this student packet with your recruit(s). In the meantime, please do not hesitate to contact us or the lead instructor should you have any questions or require further information.

Course Coordinators: Tiger Schmittendorf – Deputy Fire Coordinator Bill Taylor – Fire Protection Specialist Erie County Division of Fire Safety NYS Office of Fire Prevention & Control 716.681.7111 – [email protected] 518.380.0547 – [email protected]

JAMES M. McCULLOUGH Deputy Commissioner

Fire Safety

EARL R. SCHMITTENDORF Deputy Fire Coordinator

DANIEL J. NEAVERTH JR. Commissioner

Donning Personal Protective Equipment

Donning Personal Protective Equipment – 2002 Edition, NFPA 1001 5.1.1.2, 5.3

NEW YORK STATE DEPARTMENT OF STATE Skill Sheet 6-1

Candidate's Name Date Evaluator's Name Evaluator's Signature

The candidate, given a complete set of PPE, will don full personal protective equipment, according to manufacturer’s recommendations, within 1 minute as outlined in Delmar, Firefighter’s Handbook, 2 ed., NYS ed.

Time limit for this station is 60 seconds. Timing starts when the candidate first touches any article of turnout gear after telling the evaluator they are ready to start.

02/2007

Criteria: Pass Fail Boots

Pants (includes all fasteners and suspenders)

Protective hood

Coat (includes all fasteners and collar up and must have at least a 2 inch overlap on bunker pants per NFPA 1971)

Helmet (chin strap cinched/under chin)

Gloves (no skin at wrist exposed)

Exposed skin (no exposed skin is permitted except for facial area)

Completed in less than 61 seconds

Estimated time per attempt: 1 minute per student

Evaluator Notes

Donning Self-Contained Breathing Apparatus

Donning Personal Protective Equipment – 2002 Edition, NFPA 1001 5.1.1.2, 5.3

NEW YORK STATE DEPARTMENT OF STATE Skill Sheet 7-1

Candidate's Name Date Evaluator's Name Evaluator's Signature

The candidate, given a complete set of PPE, SCBA, and PASS device, shall don full personal protective equipment, including SCBA, according to manufacturer’s recommendations, within 2 minutes. The student may use any approved method for donning the SCBA and must be on air for the time to stop, as outlined in Delmar, Firefighter’s Handbook, 2 ed., NYS ed. JPR 7-1, 7-2, 7-3, and 7-4 Note: For SCBA without integrated PASS device, the time will not stop until the accessory PASS device has been enabled.

Time limit for this station is 2 minutes. Timing starts when the candidate first touches any article of turnout gear after telling the evaluator they are ready to start.

02/2007

Criteria: Pass Fail 1. Boots

2. Pants (includes all fasteners and suspenders)

3. Protective hood

4. Coat (includes all fasteners and collar up and must have at least a 2 inch overlap on bunker pants per NFPA 1971)

5. SCBA (approved donning method and all straps cinched)

6. SCBA facepiece (good seal and hood over spider/hair net)

7. Helmet (chin strap cinched/under chin)

8. PASS device (manually enabled if not integrated)

6. Gloves (no skin at wrist exposed)

7. Exposed skin (no exposed skin is permitted except for facial area)

8. Completed in less than 2:00 minutes

Evaluator Notes

Air Consumption Exercises

Air Consumption Exercise – 2002 Edition, NFPA 1001 5.3.1, 5.3.5

NEW YORK STATE DIVISION OF HOMELAND SECURITY AND EMERGENCY SERVICES Skill Sheet 7-7

Candidate's Name Date Evaluator's Name Evaluator's Signature

The candidate, wearing a complete set of PPE and SCBA, shall consume a complete volume of air from their SCBA while performing simulated fire ground tasks, so that their breathing rate will be increased. The objective is to obtain a better understanding of the individual work time, under fireground conditions, comparing the rate in minutes to pounds per square inch in accordance with Delmar, Firefighter’s Handbook, 2 ed., NYS ed.

-DRAFT- 02/2014

PassFail

AIR CONSUMPTION Drill # 1 walking/ talking in complete PPE/ SCBA Firefighter properly wears PPE and SCBA

Firefighter’s BOTTLE SIZE (i.e 30 min, 45 min, 60 min)

Firefighter’s STARTING Air Cylinder PSI

Firefighter’s START TIME:

Firefighter completes course as laid out by INSTRUCTOR

Firefighter’s Lap Number

Low Alarm Activation TIME:

Firefighter’s Empty Bottle END TIME:

Firefighter’s Total Operational TIME:

Air Consumption Drill # 2 Task Oriented Air Consumption / 8 Skill Stations Firefighter properly wears PPE and SCBA

Firefighter’s BOTTLE SIZE (i.e 30 min, 45 min, 60 min) Bled down to approximate 30 min cylinder pressure prior to beginning the evolution.

Firefighter’s STARTING Air Cylinder PSI

Firefighter’s START TIME:

Firefighter completes course as laid out by INSTRUCTOR (8 skill stations as per Lesson Plan)

Firefighter identifies remaining cylinder pressure after each station and communicates it to their escort

Firefighter’s Lap Number

Low Alarm Activation TIME:

Firefighter’s Empty Bottle END TIME:

Firefighter’s Total Operational TIME (TIME MUST EXCEED 10 MINUTES ON AIR):

Evaluator Notes

NYS OFPC Firefighter‐1 Task Oriented Air Consumption Evolution 

Erie County Training and Operations Center Equipment List 

Station #1 – Stair Climb – Using indoor tower stairs participants will climb to the top of the 3rd set of 

stairs and return back to the entry door while carrying a 50ft. section of 2 ½” hose packed into a dual 

stack shoulder load approximately 3ft in length.   

  Needs: 2 – 50’ sections of 2 ½” hose and duct tape to secure the hose 

Participants will read their remote pressure gauge and report their air pressure to their escort who 

will document the reading and the time after completion of each station’s task.  The escort will need 

to start the stop watch when the participant begins breathing air from their cylinder and only stops it 

when the participant exhausts the air from the cylinder and steps off the course. 

After the completion of each station, participants will then walk a recovery lap around two cones 

placed 40’ apart located in the middle of the course.  It is not required to walk a recovery lap between 

stations 2a and 2b. 

Station #2a‐ Hose stretch – The participants will drag an 1 3/4” hose and “sled” to a cone 35’ away and 

return it to the starting point.  The “sled” contains the remaining 40’ of hose and an additional 30 lbs. of 

weight in a reinforced milk crate.  The participant will place the attached nozzle and 8’ of hose over their 

shoulder and across their chest to drag the sled the required distance.  They will then proceed directly to 

Station 2b without a recovery lap around the cones. 

  Needs: 1‐ 50’ section of 1 ¾” hose, automatic fog nozzle, milk crate, 30 lbs of weight, two cones 

and method to secure hose to milk crate 

Station #2b – Hose pull – The participant will go down on at least one knee and pull the 1 ¾” hose until 

the coupling returns to them.  The 1 ¾” hose will be connected to itself and looped around the base of 

the hydrant located near the North overhead apparatus door.  The coupling will be placed at the 

furthest distance away from the hydrant.  

  Needs: 1‐50’ section of 1 ¾” hose and secured fire hydrant or bollard with room for the hose 

coupling to clear as it passes around. 

Station #3 – Saw Carry – The participant approaches the simulated apparatus cabinet and removes each 

saw from the cabinet and places it on the ground.  The participant then carries both saws and walks 75’ 

to a marked cone and returns to the simulated cabinet.  The participant then returns each of the saws to 

the cabinet one at a time. 

  Needs: 1 – rotary/ rescue saw (preferred 30 lbs  + or – 3 lbs.), fire chain vent saw (preferred 28 

lbs. + or – 3 lbs.), simulated apparatus cabinet with shelf 4’ from the ground, one cone located 75’ from 

the cabinet. 

Station #4 – Ladder raise – Participant approaches the secured 24’ extension ladder (secured to the 

simulated window at the end of the floor collapse simulator) and hoists the fly of the ladder all the way 

up using a hand over hand method without stopping and returns it to the ground in a controlled manner 

without allowing it to drop. 

Needs: 1 ‐24’ fire service extension ladder, brackets to secure the ladder to the wall that would allow 

the fly section to be extended completely out using the halyard. 

Station #5 – Forcible Entry – participants will approach the table with mounted and inflated tire and 

strike the tire with an ten pound sledgehammer until the tire moves from one end of the table and 

returns to its starting point. 

  Needs: reinforced table, mounted and inflated truck tire, ten pound sledgehammer. 

Station #6 – Search – participants will approach the first floor of the SCBA Maze and follow a right or left 

hand search pattern preceding 64’ through a darkened search area with obstacles. 

  Needs: simple pattern arranged in the first floor of the SCBA maze with some obstacles.  The 

area needs to be darkened.  (see attached document for guides to creating obstacles) 

Station #7 – Rescue – Participant approaches the 165 lb. mannequin and drags it 35’ around a cone and 

returns it to the starting point.   

  Needs: 165 lb. mannequin, one cone to mark the 35’ distance 

Station #8 – Ceiling push/ pull – participant will approach the ceiling breech simulator and complete 2‐ 

sets of 3 repetitions of pushing the ceiling plate up and 5 repetitions of pulling the hook down using a 6’ 

pike pole. 

  Needs: ceiling breech simulator, 6 ‘ pike pole without handle. (ceiling push up plate is 60 lbs. and 

the pull down mechanism is 80 lbs.) 

When the participants complete all 8 stations they proceed to station #1 and continue working the 

course until they run nearly out of air.  When they completely expend all of the air in their cylinder, the 

evolution ends for them.  Each participant’s escort will document the time and air pressure readings and 

return the document to the Participant for review.  Once the participant reviews the document they will 

give it to the lead instructor. 

To keep the flow of participants moving, assign the participants to 5 companies of 4 – 5 participants 

each.  The first company to run the course will be escorted by company 3 members.  This allows 

company 2 to be prepared to begin the course as soon as company 1 clears the course.  Company 2 will 

be escorted by company 4.  Company 3 will be escorted by company 5.  Company 4 will be escorted by 

company 1 who should be ready after their period in rehab.  Company 5 will be escorted by company 2. 

SIGNATURE OF AUTHORIZED LEGAL GUARDIAN DATE

PRINTED NAME RELATIONSHIP TO FIREFIGHTER

New York State

Department of State

Office of Fire Prevention and Control

Training Authorization LetterDOS-1654 (5/04)

To the Office of Fire Prevention and Control:

The firefighter listed below is an active member of _________________________________ Fire Department and isauthorized to attend the course indicated below. I understand this training course may contain certain evolutions thatsimulate and/or create actual firefighting or rescue conditions. The Office of Fire Prevention and Control is notresponsible and/or liable for any malfunction or damage to any equipment used during this training program.

SIGNATURE OF FIREFIGHTER DATE

PRINT NAME OF FIREFIGHTER

PRINT

And, if firefighter is under the age of 18, the following consent must be provided:

Additional copies of this form are available at http://www.dos.state.ny.us/fire/pdfs/authorization.pdf

PRINT NAME OF FIREFIGHTER

Fire FDID # Date

Department

Fill in YES or NO YES NO

The firefighter listed below has medical clearance to use Self Contained

Breathing Apparatus, (SCBA), in accordance with 29 C.F.R. part 1910.

The firefighter listed below is authorized to use SCBA

and participate in interior /exterior firefighting evolutions.

If you cannot answer the questions above because you do not know the requirements of 29 C.F.R. Part 1910 or do not know

whether the firefighter listed below is authorized to use SCBA, please contact your County Fire Coordinator or OFPC.

PLEASE PRINT ALL INFORMATION

Fire Chief Authorization

Course Information

Student Information

Last First MIName

Address City State

Home Work ZipPhone Phone

Course CourseCode # Title

( ) ( )

Print Chief’s

Chief’s Name Signature

PRINT NAME OF FIREFIGHTER

I, , parent or legal guardian ofconsent to his/her participation in the training listed above. I have read, fully understand, and agree with the above information. I understand andacknowledge that safety is important during the training course and further authorize the instructor to removefrom the simulation or course if the instructor believes that his/her behavior or abilities may cause a safety risk to himself/herself or another.

I, , have read, fully understand and agree with above information. I understandand acknowledge the importance of safety during the training course and further acknowledge that if an instructor believes that my behavior orabilities may cause a safety risk to myself or another, the instructor has the authority to remove me from the simulation or course.